Now, instead of the aforementioned criteria, there is a scoresheet that looks at joint involvement, serology, duration of synovitis, and acute phase reactants:

Joint Involvement

1 med-large joint (0 points)

2-10 med-lg joints (1 point)

1-3 small joints (2 points)

4-10 small joints (3 points)

>10 joints (at least one small joint) (5 points)

Serology

Neither RF or ACPA positive (0 points)

At least one test low positive titer (2 points)

At least one test high positive titer (3 points)

Duration of Synovitis

<6 weeks (0 points)

>6 weeks (1 point)

Acute Phase Reactants

Neither ESR nor CRP abnormal (0 points)

Abnormal CRP or abnormal ESR (1 point)

Total score of six or more points means a definite RA diagnosis, even without x-ray evidence. Doctors aren’t limited by normal sed rate, CRP, or RF. A zillion joints involved for six or more weeks equates to a positive diagnosis without it mattering one bit what any lab results might say.

Many do not have a positive RF. Whether it’s 20% or 35% or some other number doesn’t matter a whole lot. There are so many physicians who don’t realize there are other criteria. Somewhere along the line doctors without specialized training in rheumatology got the idea that a negative RF equates to the absence of RA. As you know, that’s just not true. This new scoresheet gives equal footing to the CCP test. There are now two options under serology. CCP is considered an early indicator; it can be positive a year prior to any symptoms, so acknowledgement of the value of this test is a huge step.

I’m sending this to my internist and to my rheumy-doc. My rheumy-doc probably knows it already, but it’s good to let him know that his patients know it, too. My internist is very enlightened, and also *probably* knows this, but I’m gonna tell him anyway, too.